1010 



SURGICAL ANATOMY OF THE ARTERIES. 



SURGICAL ANATOMY OF THE BRACHIAL ARTERY. 



In the operation for tying the brachial artery, the known direction of the 

 vessel, and the inner margin of the biceps muscle, chiefly aid in determining 

 its position (p. 382). In consequence of the thinness of the parts which 

 cover the artery, and the position of the basilic and median basilic veins 

 with respect to it, even the integuments must be divided with care. After 

 turning aside the superficial vein, should that be necessary, and dividing the 

 fascia, the median nerve will probably come into view, and the artery will 

 then be readily found. This is the course required under ordinary circum- 

 stance?. But it may happen that, after dividing the fascia, it will be neces- 

 sary to cut through a layer of muscular fibres in order to bring the artery 

 into view [plate 37, figs. 3, 4, 6]. The influence of pressure with the 

 finger, in controlling the circulation, will enable the surgeon to determine if 



Fig. 699. 



Fig. 699. DISSECTION OF THE AXILLA AND INSIDE OF THE ARM TO SHOW THE 

 AXILLARY AND BRACHJAL VESSELS (from R. Quain). 



The greater and lesser pectoral muscles have been divided so as to expose the axillary 

 vessels : a, the inserted portion of the pectoralis major ; b, the pectoral portion ; 1, 1, 

 axillary artery ; +,-(-, the median nerve formed by the two portions of the plexus which 

 surround the artery ; 1', placed on a part of the sheath of the brachial vessels, and 1", on 

 the lower part of the biceps muscle, point to the brachial artery surrounded by its venae 

 comites ; 2, 2, axillary vein ; 3, 3, the basilic vein ; the upper figure is placed on the 

 triceps muscle, the lower on the fascia near the junction of the ulnar vein : on the basilic 

 vein are seen the ramifications of the internal cutaneous nerve ; 4, on the deltoid and 4', 

 on the clavicular part of the great pectoral muscle, mark the cephalic vein joining the 

 acromio -thoracic and through it the axillary vein; 5, 5, placed on the divided portions of 

 the pectoralis minor, point to the origin and branches of the acromio-thoracic artery ; 6, 

 placed on a group of axillary glands, indicates the alar thoracic and subscapular vessels ; 

 7, placed on the trunk of the axillai-y vein, points by a line to one of the venae coraites of 

 the brachial vein, which being joined by the other higher up passes into the axillary vein : 

 the ulnar nerve is seen passing from below the basilic vein towards the inner condyle ; 

 near 1, placed on the coraco-brachialis muscle is seen the musculo-cutaneous nerve before 

 it passes through that muscle. 



